The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body)   hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump.  Tumor  means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35   50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy   chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team   Integrated Liver Care team

The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

The Increasing Problem Of Liver Tumours In India!

It s been long known about the numerous health benefits of beetroot. Surprisingly though, beetroot has some not-so-known qualities such as increasing stamina, removing skin blemishes and increasing the glow of the face. Apart from this, it can fetch benefits to the skin, hair and the overall health. In this article, we will discuss the benefits of beetroot consumption in vivid detail.

Reduces the impact of aging: Beetroot being a great antioxidant successfully blocks free radicals and helps to fight the symptoms of aging. All it requires is a medium slice beetroot. The juice should be extracted from it and the pulp needs to be removed. The juice then could be applied to the face using cotton balls. Applying this simple solution once in a week can fetch dramatic results.
Reduces blemish and pigmentation: Beetroot is one of the few vegetables that have a large amount of vitamin C embedded in it. It helps the skin to retain its original color, reduces blemishes and pigmentation. 3-4 cubes of beetroot serving twice a week should do the trick.
Hair loss: Beetroot is a great source of food to stay away from hair loss. Being a good source of potassium, beetroot can prevent hair loss and enhance hair growth. A weekly serving of 3-4 cube of beetroot over a span of few months will show visible results.
Improves liver function: Beetroot contains glutathione that is known to be a great agent for the liver. It acts as a detox diet and helps in functioning of the liver. This liver, in turn, helps the body to detox. Beetroot also helps in the regeneration of cells of the liver.
Boost hemoglobin: Beetroot is an excellent source of iron and folate. These are the nutrients that are required for the body to maintain an adequate amount of hemoglobin in the body. A deficiency in the hemoglobin level can lead to anemia. Regular consumption of beetroot can ensure that a person refrains from deadly diseases such as anemia.
Fight inflammation: Some typical symptoms of inflammation include infection, trauma etc. This is a sign of the immune system not acting efficiently against sudden panic. Some typical symptoms include pain, redness, swelling etc. Beetroot in known to have a super-efficient anti-inflammatory response. Injection of beetroot is often suggested by medical practitioners.
Cancer prevention: Beetroot can elevate the level of oxygen in the blood. Since cancer cells are acidic in nature, beetroot can successfully neutralize them due to its alkaline nature. Owing to this anti-cancer properties, oncologists often suggests the intake of beetroot juice on a regular basis to patients suffering from liver, rectal, colon and various other types of cancer. 2 glasses of beetroot juice are often recommended for cancer patients.

Beetroot (Chukundar) - 7 Reasons Why You Must Eat Them!

Liver disorders are very common. Gastroenterologists trained in liver diseases are known as Hepatologists.Symptoms of liver disease include jaundice, vomitting of blood(Hemetemesis), bleeding in the motions(also known as Melena or hematochezia),altered sensorium known as Hepatic encephalopathy(HE), Renal failure also known as Hepatorenal syndrome(HRS), Breathlessness (due to Hepatopulmonary syndrome and portopulmonary hypertension).

Let s understand the liver disease point by point: 

1. Hepatitis B: Hepatitis B is a virus which is usually acquired in four ways. Unprotected sexual intercourse with the infected partner, from infected to the child, infected needles, infected blood. It takes many years for the hepatitis B virus to cause liver damage. Once the liver is damaged it is called Cirrhosis or chronic liver disease. When liver is more then 80 percent damage, it causes blood vomiting also known as hematemesis, Ascites(water in the stomach), Jaundice, HE, HRS etc. Treatment depends on virus count which is calculated by HBV DNA PCR and other lab parameters. Once the treatment starts monitoring of viral count is done to document the effectiveness of the treatment. All the family members and sexual partners must get HbsAg screening done to detect early silent infection. All those who test negative, Hepatitis vaccination should be done, by three injections which provide them with 100% protection against the HBV infection.

2. Hepatitis C: Hepatitis C is a virus which is acquired by injection drug abuse and infected needles and blood. Transmission by unprotected sexual intercourse is possible but chances are very low. Hepatitis C virus damages the liver slowly and takes years before clinical symptoms of liver failure appear. Once the liver is damaged it is called Cirrhosis or chronic liver disease. When the liver is more than 80 percent damage, it causes blood vomiting also known as hematemesis, Ascites(water in the stomach), Jaundice, HE, HRS etc. All hepatitis C virus infected patients must be treated irrespective of virus count. Baseline virus count by HCV RNA  is done to measure the effectiveness of the treatment. HCV Genotype is done for patients with cirrhosis. Vaccination is not available for hepatitis C but newer medicines(Direct acting antivirals DAA) for Hepatitis C can cure it with more than 95% certainty.

3. Acute viral Hepatitis: Sudden infection in the liver can be due to multiple causes but commonly is due to Hepatitis A and Hepatitis E, which are caused due to eating or drinking contaminated food and water. Rarely Hepatitis B and Hepatitis C can cause Acute hepatitis including Acute liver failure. Acute hepatitis presents with Jaundice, loss of appetite, generalised fatigue, vomiting and abdominal pain.  Patients are usually treated on an outpatient basis but if they have severe vomiting, abdominal pain or altered sensorium, they are admitted for inpatient care and monitoring. Drugs or complementary and alternative medicines (CAM) such as herbal or bodybuilding protein supplements which contain steroids and heavy metals can cause acute hepatitis.

4. Liver transplant: Removing the damaged liver and to put a new liver in the patients is called Liver transplant. Liver transplant is major surgery and costs around 20 to 30 Lacs. Indications of liver transplant are an acute liver failure due to hepatitis viruses such as hepatitis A, Hepatitis B, Hepatitis C and Hepatitis E, decompensated cirrhosis due to any cause including chronic hepatitis B and C, Drug-induced liver failure such antitubercular drugs(ATT). The donor for liver transplant is either a close relative (Living donor liver transplant LDLT) or a brain dead donor (deceased donor liver transplant DDLT).

5. Chronic liver disease or Cirrhosis: It is the end result of slow damage to the liver, where many liver cells are damaged and replaced by fibrosis. Apart from viruses such as Hepatitis B and Hepatitis C, Alcohol is one of the most common causes of cirrhosis.

Drinking alcohol for years together causes irreversible liver damage causing cirrhosis. Alcohol can cause acute severe hepatitis, acute liver failure and chronic liver disease.  Patients with suspected heavy alcohol drink must-visit Hepatologist (Liver doctor ) for proper diagnosis of stage of liver damage and deaddiction programme. USG Abdomen, blood tests, endoscopy and Fibroscan is usually done to know the liver health.

Fatty liver is also known as non-alcohol fatty liver disease(NAFLD) is a lifestyle disorder due to lack of exercise, high fat diet, obesity and due to drugs. Fatty liver causes silent liver damage and if not recognised in time can cause irreversible liver damage and cirrhosis. The evaluation includes Liver function tests, Ultrasound abdomen, Fibroscan. Treatment includes daily moderate-intensity aerobic exercise, drinking coffee and a low-fat diet. Few medicines are available which help in the reversal of fatty liver.

What Should You Know About Liver Disorders?

Cirrhosis of the liver is a chronic and progressive condition in which the liver gets damaged and healthy liver tissue is replaced with scar tissue, ultimately causing dysfunction of the liver. Liver damage obstructs the circulation to the liver and also hinders the processing of nutrients, hormones, drugs, toxins as well as the production of proteins and other substances made by the liver. Liver cirrhosis is caused due to hepatitis C, fatty liver, alcohol abuse, viral infections, inherited diseases, and as a toxic reaction to drugs and environmental waste products. The modern management of this condition involves diet modification, reduction in salt intake, total abstinence from alcohol, and avoiding all the causative factors of this condition.

Cirrhosis of liver causes multiple symptoms in the body including fluid collection in the abdomen, bleeding varices in the stomach, chronic heart failure, damage to the central nervous system, and various metabolic disorders in the body. Advanced cirrhosis of liver is ultimately fatal.

Ayurvedic Treatment

It is therefore of prime importance to commence treatment at the earliest possible. It is of utmost importance to treat the known cause of the condition. Ayurvedic herbal medicines have a definite action on the hepatic cells and can effectively treat inflammation within the liver. Ayurvedic medicines can also treat infection as well as metabolic dysfunction of the liver, and protect it from the toxic effects of drugs and environmental wastes. Ayurvedic medicines can therefore be effectively used to treat all the known causes of liver cirrhosis.
Liver damage causes healthy cells to be replaced with scar tissue. This is preceded by a process of inflammation, swellingand gradual death of the liver cells. Early institution of Ayurvedic treatment can help dramatically reduce inflammation and swelling and thereby preserve the liver cells and prevent unnecessary damage. Even in the early phase of scar deposition. Ayurvedic herbal medicines can help remove scar tissue, minimize permanent liver damage, and help regenerate damaged or near-dead cells Ayurvedic herbal medicines, therefore, form a comprehensive treatment therapy for liver cirrhosis.
The other symptoms resulting from liver cirrhosis such as ascites, esophageal varices, congestive cardiac failure and metabolic disorders start improving automatically when the obstruction in the liver is treated and removed. However, Ayurvedic medicines can treat these symptoms independently too, if these are observed to be severe in the affected individual and require urgent medical care. Improved functioning of the liver also helps to improve the overall metabolism and nutrition of the body and metabolize toxic substances within the body. Prompt and aggressive Ayurvedic treatment, therefore, helps comprehensively treat liver cirrhosis and significantly reduce morbidity and mortality resulting from this disease.
Cirrhosis can also adversely affect the central nervous system and cause psychotic symptoms and permanent nerve damage. Prompt treatment with Ayurvedic herbal medicines also helps to preserve the brain function and treat the associated symptoms. If required, brain damage can be treated separately with herbal medicines which strengthen the nervous system and help rejuvenate nerve cells. Medicines which act on the nervous system also help improve confidence and self-control and are therefore equally useful in helping the affected individual abstain completely from alcohol, which is a known and predominant cause of cirrhosis.
Depending upon the severity of the condition, most individuals affected with cirrhosis require regular and aggressive Ayurvedic herbal treatment for periods ranging from six to eighteen months, in order to obtain significant benefit and a possible complete cure from the condition. Ayurvedic treatment thus has a definite role to play in the management and treatment of cirrhosis.

Cirrhosis Liver - Ayurvedic Remedies That Can Help!

Ulcerative colitis is a disorder that causes inflammations and ulcers inside your colon, affecting the entire digestive system. The disease grows over time and symptoms start to worsen over a prolonged period, rather than the problem showing up suddenly. Severe cases of ulcerative colitis may even be fatal if treatment does not resolve some of the complications arising from the condition.

Causes of Ulcerative Colitis-
The exact cause for the inflammatory bowel disease is unknown. Improper diet and lifestyle can aggravate the symptoms, but do not cause the condition. Some possible causes for the disease include-

Improper functioning of the body s immune system causes it to recognize the colon as a foreign body.
Genetic factors and hereditary may also be held accountable in some instances.
Risk factors for the condition include old age and family history of the condition.

Symptoms of Ulcerative Colitis-
Here are some common symptoms associated with the condition-

Bloody diarrhoea
Rectal pain
Weight loss
Pain in the abdominal region along with cramping
Fever
Urgency to defecate
Inadequate bowel movement despite the feeling of urgency
How can you prevent ulcerative colitis?
Ulcerative colitis cannot be prevented as the exact cause for the condition is unknown. However, there are simple steps that will help manage the symptoms.

Diet change- You need to stop eating certain foods, such as, dairy products, beans, broccoli, cabbage and anything spicy. Instead, fibre intake must be increased drastically.
Exercise- Mild exercise or activities have a profound impact on managing the condition.
Avoiding stress
Drinking plenty of fluids
Role of Homeopathy in Managing Ulcerative Colitis-
Homeopathy follows a natural and holistic approach to deal with the condition. It does not merely treat the symptoms, but looks to cure the underlying cause for those symptoms. Homeopathic remedies will greatly bolster the overall condition of the body s immune system. Furthermore, the bloody diarrhoea accompanying the disease will also stop with proper homeopathic treatment.

Ulcerative Colitis - Does Homeopathic Treatments Work?

Liver is a very important organ of your body. It is also the largest internal organ. Liver plays a pivotal role in food digestion, iron metabolism, regulation of blood clotting and removal of toxins from your body. Liver problems refer to the disruption of liver functions. There are various liver problems and diseases that you may encounter. Some of the liver problems are as follows:

Hepatitis A, B, C, D, E
Liver cirrhosis.
Fatty liver
Liver cancer
Wilson disease
Jaundice
The most common causes of the above mentioned liver problems are

Fatty liver is generally caused due to obesity
Hepatitis A, B, C is caused due to viral infections
Consuming excess alcohol can cause liver cancer
Liver diseases like Wilson disease is caused due to genetic problems
Different liver problems have different symptoms. But there are some common symptoms for all liver diseases. The most common symptoms are mentioned below

Body fatigue
Pain in the abdomen
Change in urine and stool color
Nausea
Queasiness
Loss of weight and appetite
Yellowish discoloration of skin, eyes and nails.
Homeopathy can treat liver problems very effectively. The following are some of the solutions offered by homeopathy for different liver problems
1. If you are suffering from the problem of fatty liver, your doctor may recommend you medicines like Lycopodium, Phosphorus, Nux vomica
2. If you suffer from the problem of liver enlargement then your doctor may recommend you medicines like Carduus Marianus
3. Chionanthus and Taraxacum are medicines advised for liver problems like jaundice
4. Natrum sulphuricum may be recommended to you if you are suffering from problems like Liver cirrhosis
Homeopathic treatment for liver problems is very effective since it treats the medical condition according to specific symptoms

Liver Problems - How they Can be Treated with Homeopathic Remedies?

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